Dysgerminomas

STANDARD TREATMENT OPTIONS:

• For patients with stage II dysgerminoma, total abdominal hysterectomy and bilateral salpingo-oophorectomy are usually performed. However, for the younger patient anxious to preserve fertility, a unilateral salpingo-oophorectomy can be considered standard therapy at this time; adjuvant chemotherapy should be given.

  These patients should receive adjuvant treatment. Options include radiation therapy or chemotherapy. A disadvantage of the former is loss of fertility due to ovarian failure. Experience with adjuvant chemotherapy is limited, but considering the effectiveness of chemotherapy in tumors other than dysgerminoma and in advanced stage dysgerminoma, it is likely to be effective and to allow recovery of reproductive potential in patients with an intact ovary, tube, and uterus. Thus, adjuvant cisplatin, etoposide, and bleomycin have replaced radiation therapy except in the rare patient in whom chemotherapy is not considered appropriate.

Other Germ Cell Tumors

STANDARD TREATMENT OPTIONS:

• For patients with stage II germ cell tumors other than pure dysgerminoma, unilateral salpingo-oophorectomy should be performed when fertility is to be preserved. Although there is considerable experience with VAC (vincristine/dactinomycin/cyclophosphamide), especially when given in an adjuvant setting, combinations containing bleomycin, etoposide, and cisplatin (BEP) are more effective.[1,2,3] Patients who do not respond to a cisplatin-based combination may still attain a durable remission with VAC as salvage therapy.[4] Recurrence after 3 courses of BEP as adjuvant therapy is rare.[4] All patients who do not respond to standard therapy are candidates for clinical trials. When there is residual disease or elevated levels of AFP or HCG after maximal surgical debulking, 3 or 4 courses of BEP combination chemotherapy are indicated.[5]

  Evidence suggests that second-look laparotomy is not beneficial in patients with initially completely resected tumors who receive cisplatin-based adjuvant treatment.[6] Second-look surgery may be of benefit for a minority of patients whose tumor was not completely resected at the initial surgical procedure and who had teratomatous elements in their primary tumor.[6,7] Surgical resection of residual masses detected by clinical examination, by radiographic procedures, or at re-exploration should be undertaken since reversion to germ cell tumor has been described.

TREATMENT OPTIONS UNDER CLINICAL EVALUATION:

• Patients with stage II germ cell tumors of the ovary are candidates for clinical trials.[4] Information about ongoing clinical trials is available from the NCI Web site .

Current Clinical Trials

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage II ovarian germ cell tumor. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.

General information about clinical trials is also available from the NCI Web site.

References:

1. Williams S, Blessing JA, Liao SY, et al.: Adjuvant therapy of ovarian germ cell tumors with cisplatin, etoposide, and bleomycin: a trial of the Gynecologic Oncology Group. J Clin Oncol 12 (4): 701-6, 1994.
2. Pinkerton CR, Pritchard J, Spitz L: High complete response rate in children with advanced germ cell tumors using cisplatin-containing combination chemotherapy. J Clin Oncol 4 (2): 194-9, 1986.
3. Gershenson DM, Morris M, Cangir A, et al.: Treatment of malignant germ cell tumors of the ovary with bleomycin, etoposide, and cisplatin. J Clin Oncol 8 (4): 715-20, 1990.
4. Williams SD, Blessing JA, Moore DH, et al.: Cisplatin, vinblastine, and bleomycin in advanced and recurrent ovarian germ-cell tumors. A trial of the Gynecologic Oncology Group. Ann Intern Med 111 (1): 22-7, 1989.
5. Williams SD, Birch R, Einhorn LH, et al.: Treatment of disseminated germ-cell tumors with cisplatin, bleomycin, and either vinblastine or etoposide. N Engl J Med 316 (23): 1435-40, 1987.
6. Williams SD, Blessing JA, DiSaia PJ, et al.: Second-look laparotomy in ovarian germ cell tumors: the gynecologic oncology group experience. Gynecol Oncol 52 (3): 287-91, 1994.
7. Gershenson DM: The obsolescence of second-look laparotomy in the management of malignant ovarian germ cell tumors. Gynecol Oncol 52 (3): 283-5, 1994.